Document Code NSG-F0-00__

Revision 00
Effectivity Date 2022/07/01
SCHOOL OF HEALTH AND NATURAL SCIENCES Page/s 1 of 1

PERFORMANCE EVALUATION TOOL FOR BURPING THE BABY

Direction: Below is a list of criteria to evaluate the student’s skills in Burping the Baby. Indicate your
evaluation by placing the number of scores on the appropriate column using the following
description scale.

0- Not Done 1- Incorrectly Done 2- Correctly Done

OVER THE SHOULDER 0 1 2 Remarks

1. Place a cloth over your shoulder
2. Hold the baby so that his head is on your shoulder.
Support the head
3. Gently ad firmly pat or rub the baby’s back
LYING DOWN
1. Put a cloth on your knees or on the floor sine the baby will
bring a little milk up too.
2. Alternatively, lie the baby’s stomach down across your
knees or lap
3. Gently and firmly pat or rub the baby’s back
ON THE LAP
1. Sit the baby upright. Lean his weight forward against the
heel of your hand
2. Gently and firmly pat or rub the baby’s back
TOTAL AVERAGE:

Comments/
Suggestions:__________________________________________________________________________________________________________
____________________________________________________________________________________________________________

Student’s signature over printed name / Date / Time:_______________________________________________________

Clinical Instructor’s signature over printed name/ Date/ Time:________________________________________________